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. 2014 Sep 28;20(36):12981-92.
doi: 10.3748/wjg.v20.i36.12981.

Laparoscopic natural orifice specimen extraction-colectomy: a systematic review

Albert M Wolthuis  1 , Anthony de Buck van Overstraeten  1 , André D'Hoore  1
Affiliations

Laparoscopic natural orifice specimen extraction-colectomy: a systematic review

Albert M Wolthuis et al. World J Gastroenterol. .

Abstract

Over the last 20 years, laparoscopic colorectal surgery has shown equal efficacy for benign and malignant colorectal diseases when compared to open surgery. However, a laparoscopic approach reduces postoperative morbidity and shortens hospital stay. In the quest to optimize outcomes after laparoscopic colorectal surgery, reduction of access trauma could be a way to improve recovery. To date, one method to reduce access trauma is natural orifice specimen extraction (NOSE). NOSE aims to reduce access trauma in laparoscopic colorectal surgery. The specimen is delivered via a natural orifice and the anastomosis is created intracorporeally. Different methods are used to extract the specimen and to create a bowel anastomosis. Currently, specimens are delivered transcolonically, transrectally, transanally, or transvaginally. Each of these NOSE-procedures raises specific issues with regard to operative technique and application. The presumed benefits of NOSE-procedures are less pain, lower analgesia requirements, faster recovery, shorter hospital stay, better cosmetic results, and lower incisional hernia rates. Avoidance of extraction site laparotomy is the most important characteristic of NOSE. Concerns associated with the NOSE-technique include bacterial contamination of the peritoneal cavity, inflammatory response, and postoperative outcomes, including postoperative pain and the functional and oncologic outcomes. These issues need to be studied in prospective randomized controlled trials. The aim of this systematic review is to describe the role of NOSE in minimally invasive colorectal surgery.

Keywords: Colorectal surgery; Gastrointestinal endoscopy; Laparoscopy; Natural orifice specimen extraction; Natural orifice specimen extraction-colectomy; Transanal; Transanal minimally invasive surgery; Transcolonic; Transrectal; Transvaginal.

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Figures

Figure 1
Figure 1
Study flow chart: Search strategy. NOSE: Natural orifice specimen extraction.
Figure 2
Figure 2
Evolution of publications on natural orifice specimen extraction-colectomy.
Figure 3
Figure 3
Transanal natural orifice specimen extraction. A laparoscopic transanal transabdominal-total mesorectal excision (TME) was performed. The TME-specimen with the vascular pedicle (black arrow) and colon used for the reconstruction and the hand-sewn anastomosis (white arrow) can be observed.
Figure 4
Figure 4
Transvaginal natural orifice specimen extraction. The sigmoid colon has been resected, and the anvil from a 29 mm circular stapler has been sutured into the proximal colon with a purse string. Note the wound retractor protecting the vagina.
See this image and copyright information in PMC

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